翼管神经切断术治疗难治性变应性鼻炎的分子机制
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摘要
目的探讨低温等离子鼻内镜下翼管神经切断术治疗难治性变应性鼻炎的分子机制。方法选取我科自2012年5月—2018年6月住院的63例难治性变应性鼻炎患者作为实验组进行低温等离子鼻内镜下翼管神经切断术。选取同时期58例难治性变应性鼻炎患者作为对照组进行药物保守治疗。分析两组患者治疗前后的鼻腔呼出气一氧化氮、血清嗜酸性粒细胞变化水平及组间差异。结果术后随访3个月,实验组44例显著改善,8例明显改善,11例无效,总有效率达82.5%。对照组随访3个月,13例显著改善,21例明显改善,24例无效,总有效率达58.6%。两组治疗前后鼻腔呼出气一氧化氮、血清嗜酸性粒细胞均下降,且差异具有统计学意义(P<0.05)。结论低温等离子鼻内镜下翼管神经切断术可以降低难治性变应性鼻炎患者的鼻腔呼出气一氧化氮、血清嗜酸性粒细胞水平,可考虑作为疗效判断的指标。
Objective To investigate the molecular mechanism of endoscopic vidian neurectomy by coblator in intractable allergic rhinitis.Methods 63 patients with intractable allergic rhinitis who were hospitalized in our department from May 2012 to June 2018 were selected as the experimental group for endoscopic vidian neurectomy by coblator.58 patients with intractable allergic rhinitis were selected as the control group for drug treatment,the changes of nasal exhaled nitric oxide and serum eosinophils and differences between two groups were analyed.ResultsAfter 3 months follow-up,44 patients in the experimental group improved significantly,8 patients improved,11 patients were ineffective,and the total effective rate was 82.5%.On the other hand,the control group had 13 cases significantly improved,21 cases improved and 24 cases ineffective,and the total effective rate was 58.6%.After treatments,the nasal exhaled nitric oxide and serum eosinophils were significantly decreased in the two groups.There was significant difference between the two groups(P<0.05).Conclusion Endoscopic vidian neurectomy by coblator can significantly reduce the levels of nasal exhaled nitric oxide and serum eosinophils in patients with intractable allergic rhinitis.Nasal exhaled nitric oxide and serum eosinophils can be considered as indicators of efficacy after surgegy.
Objective To investigate the molecular mechanism of endoscopic vidian neurectomy by coblator in intractable allergic rhinitis.Methods 63 patients with intractable allergic rhinitis who were hospitalized in our department from May 2012 to June 2018 were selected as the experimental group for endoscopic vidian neurectomy by coblator.58 patients with intractable allergic rhinitis were selected as the control group for drug treatment,the changes of nasal exhaled nitric oxide and serum eosinophils and differences between two groups were analyed.ResultsAfter 3 months follow-up,44 patients in the experimental group improved significantly,8 patients improved,11 patients were ineffective,and the total effective rate was 82.5%.On the other hand,the control group had 13 cases significantly improved,21 cases improved and 24 cases ineffective,and the total effective rate was 58.6%.After treatments,the nasal exhaled nitric oxide and serum eosinophils were significantly decreased in the two groups.There was significant difference between the two groups(P<0.05).Conclusion Endoscopic vidian neurectomy by coblator can significantly reduce the levels of nasal exhaled nitric oxide and serum eosinophils in patients with intractable allergic rhinitis.Nasal exhaled nitric oxide and serum eosinophils can be considered as indicators of efficacy after surgegy.
引文
[1]吴烽芳,沈炳宏,蔡耿明,等.低温等离子鼻内镜下翼管神经切断术治疗难治性变应性鼻炎的疗效分析[J].中国卫生标准管理,2017,8(20):65-67.
[2]Hsu CY,Shen PH,Weitzel EK.Endoscopic vidian neurectomy assisted by power instrumentation and coblation[J].J Chin Med Assoc,2013,76(9):517-520.
[3]何平,金晓杰,赵辉.低温等离子翼管神经高选择性分支切断术对变应性鼻炎患者鼻黏膜细胞中血管活性肠肽水平的影响[J].临床耳鼻咽喉头颈外科杂志,2018,32(3):167-170.
[4]赵娜,石磊.翼管神经切断术的研究进展[J].中国耳鼻咽喉颅底外科杂志,2016,22(1):81-84.
[5]冀永进,安云芳,薛金梅,等.鼻内镜下经蝶筛隐窝单侧翼管神经切断术治疗变应性鼻炎的疗效分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(19):1455-1458.
[6]朱梦璐,侯冉,赵长青,等.翼管神经切断术与保守方式治疗中重度变应性鼻炎疗效的Meta分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(15):1171-1176.
[7]Su WF,Liu SC,Hsu WC,et al.Randomized,double-blind,controlled study to evaluate the effect of vidian nerve cauterization on lacrimation[J].Am J Rhinol Allergy,2014,28(3):255-259.
[8]Alving K,Weitzberg E,Lundberg JM.Increased amount of nitric oxide in exhaled air of asthmatics[J].Eur Respir J,1993,6(9):1368-1370.
[9]野栩梅,倪松石.过敏性鼻炎与支气管哮喘患者的Fe NO比较研究[J].临床肺科杂志,2014,19(10):1764-1767.
[10]刘承耀,王向东,郑铭,等.鼻用糖皮质激素对变应性鼻炎和非变应性鼻炎患者鼻呼吸道一氧化氮浓度的影响[J].中国耳鼻咽喉头颈外科,2018,25(6):309-313.
[11]Hesselmar B,Sj?berg F,Saalman R,et al.Pacifier cleaning practices and risk of allergy development[J].Pediatrics,2013,13(6):e1829-e1837.
[12]李雪盛,钱进,李厚恩.变应性鼻炎外周血嗜酸性粒细胞含量及其辅助诊断价值[J].中国实验诊断学,2016,20(12):2070-2071.
[2]Hsu CY,Shen PH,Weitzel EK.Endoscopic vidian neurectomy assisted by power instrumentation and coblation[J].J Chin Med Assoc,2013,76(9):517-520.
[3]何平,金晓杰,赵辉.低温等离子翼管神经高选择性分支切断术对变应性鼻炎患者鼻黏膜细胞中血管活性肠肽水平的影响[J].临床耳鼻咽喉头颈外科杂志,2018,32(3):167-170.
[4]赵娜,石磊.翼管神经切断术的研究进展[J].中国耳鼻咽喉颅底外科杂志,2016,22(1):81-84.
[5]冀永进,安云芳,薛金梅,等.鼻内镜下经蝶筛隐窝单侧翼管神经切断术治疗变应性鼻炎的疗效分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(19):1455-1458.
[6]朱梦璐,侯冉,赵长青,等.翼管神经切断术与保守方式治疗中重度变应性鼻炎疗效的Meta分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(15):1171-1176.
[7]Su WF,Liu SC,Hsu WC,et al.Randomized,double-blind,controlled study to evaluate the effect of vidian nerve cauterization on lacrimation[J].Am J Rhinol Allergy,2014,28(3):255-259.
[8]Alving K,Weitzberg E,Lundberg JM.Increased amount of nitric oxide in exhaled air of asthmatics[J].Eur Respir J,1993,6(9):1368-1370.
[9]野栩梅,倪松石.过敏性鼻炎与支气管哮喘患者的Fe NO比较研究[J].临床肺科杂志,2014,19(10):1764-1767.
[10]刘承耀,王向东,郑铭,等.鼻用糖皮质激素对变应性鼻炎和非变应性鼻炎患者鼻呼吸道一氧化氮浓度的影响[J].中国耳鼻咽喉头颈外科,2018,25(6):309-313.
[11]Hesselmar B,Sj?berg F,Saalman R,et al.Pacifier cleaning practices and risk of allergy development[J].Pediatrics,2013,13(6):e1829-e1837.
[12]李雪盛,钱进,李厚恩.变应性鼻炎外周血嗜酸性粒细胞含量及其辅助诊断价值[J].中国实验诊断学,2016,20(12):2070-2071.